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Moms and Eating Disorders

Five years ago, my son, Henry, died just one month after he was born. In the awful hours that passed after his delivery and then his death, I endured a metaphorical injury of my own: A hole opened up in my heart, and my arteries began pumping despair into every nook and crevice in my body. I suffered all the scary psych 101 stuff you might imagine -- anxiety, depression, dreams of suicide. But I also struggled with something one might not expect: anorexia, an impulse doctors are finding lies in wait for many mothers.

We tend to think of it as a teenage affliction. And, indeed, that's when I first felt its pull. While eating disorders like anorexia and its sib, bulimia, are about striving for a cultural body ideal, they are also about the push for perfection, the desire to gain some sense of command in an out-of-control situation by micromanaging what or how you eat. And, really, who feels more out of control than new mothers?

You can't make your child sleep through the night.

You can't make your partner feel, in his own bones, the weight of your exhaustion.

You can't make, if you're me, the world spin in reverse and redo Henry's birth.

But you can make yourself skinny. You can make yourself throw up. And mothers, in unprecedented numbers, are now doing exactly that.

Who's vulnerable?

There are more than 5 million Americans who have a clinical eating disorder -- meaning their symptoms meet the medical criteria -- and probably millions more who have an unhealthy relationship with food. In fact, a recent survey of 4,000 women between the ages of 25 and 45 found that 75 percent of them don't eat or think about food in a normal way.

Treatment centers are seeing an increase in adult women seeking therapy for their eating disorders. At the Remuda Ranch in Wickenburg, Arizona, for instance, the number of women between 30 and 40 has risen 300 percent in the past seven years, according to Edward J. Cumella, Ph.D., executive director of the eating- and anxiety-disorders clinic. And the centers are responding to this demand by tailoring treatment tracks just for these women, many of whom are moms.

Denise Delmers of Shelburne, Vermont, was one of them. A mom of three, Delmers always felt she had to be perfect.

"I was supposed to do everything and be everything for my daughters, my husband, and my job -- that was my role. And if I couldn't do it, I was a failure," she says. The one thing she could do for herself was to get back to her high school weight. "Looking thin and attractive was something I could do really well," she says. To lose weight, she began to run, setting an eight-mile-a-day goal that she pushed herself to meet, no matter what. And she became anorexic.

For years she was in denial, feeling that she had a handle on her weight. Finally, her husband, her parents, and her colleagues at work convinced her that things really weren't okay. When she checked herself into a center to get treatment, she weighed 87 pounds. She is five feet five inches tall.

Delmers's quest for perfection doesn't surprise the experts. "Many of the anorexic and bulimic moms I see do everything," says Margo Maine, Ph.D., a clinical psychologist specializing in eating disorders and coauthor of The Body Myth: Adult Women and the Pressure to Be Perfect.

"They work outside the home, they volunteer, they're the ideal parent -- and they're expected to be all that and more without any role models that have gone before them to show them how, since their own mothers weren't typically expected to work outside the home. We're out there, all of us twenty-first century moms, on our own, and we're understandably overwhelmed by all that's expected of us."

Of course, not every mom translates the challenges of motherhood into an eating disorder -- the equation seems weighted by biology and circumstance. Like me, 80 percent of adult women with eating disorders had similar issues with food when they were younger. It's part of their makeup. Studies on families and twins have suggested that you're 12 times more likely to have anorexia if a relative battled the disease in the past, and 4 times more likely to develop bulimia if a family member has experienced it, too. And scientists now think you have more than a 50 percent chance of inheriting a genetic tendency for bulimia or anorexia.

Research has also shown that women who are prone to anxiety, depression, and obsessive-compulsive behaviors are more vulnerable -- and for those women, anorexia or bulimia can be triggered by the everyday stress and chaos that comes from raising kids, says Dena Cabrera, a clinical psychiatrist who works with the moms' groups at Remuda Ranch. Another trigger: sleep deprivation, which can contribute to depression and feeling out of control.

Gretchen Sortzi, a former anorexic, gained 100 pounds when she got pregnant. "After my daughter was born, I didn't recognize my body," she says. Sortzi, of Enola, Pennsylvania, started "obsessing about every calorie," lost 40 pounds in the first 12 weeks, and 60 more by her daughter's first birthday. But the loss came at a huge cost, emotionally and physically. "I was consumed by my quest for a perfect body and the shame that went with starving myself. I was wracked with arthritis, lost an inch and a half of height, and had to spend about $50,000 on my teeth, which were ruined from being malnourished," she says.

Micromanaging our postbaby bodies instead of our overly stuffed lives can feel like the surest way to gain a semblance of control. It makes a weird kind of sense; after all, starvation is a drug. Like alcohol and marijuana, it numbs you, distracts you. It keeps you from feeling what's going on in your life. For me, this held immense appeal -- in college, when I felt at sea, and after Henry died, when even the microscopic spaces between my cells seemed to ache.

The media's pressures

Let's say you have this biological predisposition. Then you add to that our cultural imperative for youthful beauty and all the fawning over the perfect postbaby bodies of celeb moms like Jennifer Lopez and Naomi Watts.

"As we see more and more cases of eating disorders in adult women, we're getting a better sense of what's going on," says Cumella. "And I think it hinges on this time and place in our culture, which is obsessed with weight and youth and body perfection to a degree that we've never seen before."

Holly Grishkat, Ph.D., the site director for outpatient programs at the Renfrew Center, a foundation for researching and treating eating disorders based in Philadelphia, calls it "the Desperate Housewives effect." "What we're seeing now on TV shows where many of the actors are in their forties but look like they're in their twenties is the not-at-all-subtle message that not only can suburban mothers and housewives be thin and beautiful and youthful at any age -- they should be," she says.

A recovering anorexic, Katie Harrison says her biggest struggle is having to tune out this media obsession. "There's a lot of pressure out there to lose weight and go on diets," says the Arroyo Grande, California, mom of two girls. "When I see pictures of celeb moms, I know all of it is airbrushed, but still part of me wants to follow those diets and exercise regimens. But I can't go there because I know I'd take it to extremes."

Like mother, like daughter?

Now that she's maintained a healthy weight of 130 pounds for the past three years, Sortzi is fighting back against these pressures -- for her daughter's sake. "Society says that women are supposed to look the same pre- and postbaby, but we, the women whom society is supposedly constricting, accept it," she says. "We say, 'Look, this is the standard.' And we try like hell to meet it. We don't fight it. We fight to reach it. Sure, society throws us a lot of nonsense, but we have to realize that we perpetuate the nonsense -- and that we can stop it, too."

Harrison says she's very aware that her two daughters, ages 1 and 2, are at higher risk for developing an eating disorder. "I have to stay strong, for myself and for my family," she says. "I sometimes feel like skipping a meal. It's irrational, but I feel if I eat breakfast, for example, I won't be able to fit into my jeans. So it's a struggle, but in the end, I eat the meal because I want my girls to know that it's healthy for them to eat breakfast."

Delmers, who is still in therapy, is also trying hard to be a good role model to her daughters by avoiding standing in front of the mirror and making comments about her body. But she does worry that her girls are picking up on her struggle, especially at mealtimes, when she finds it difficult to eat more than a salad while the rest of her family has a normal dinner.

"It's better to get the issue out in the open," says Cabrera. "You can tell your child, 'Mommy has a hard time with food, just like you have a hard time doing your math homework.' Communicating and sharing your feelings is much better for the whole family than keeping your struggle a secret."

That's why it's so important for moms to get help. We want our kids to feel good about their bodies, weight, and shape, and we need to be their role models for a healthy lifestyle, says Cabrera. But it's even more critical for the mom herself. Without treatment, she can't fully be in the moment and enjoy her kids because she is too busy living inside her head, trapped in her fear, shame, and guilt.

In the end, after flirting with the urge to contain my pain by containing what I ate, I couldn't do it. I couldn't embrace anorexia as I had before, basically because when Henry died, I learned, in the most brutal way, that some things in life are beyond control.

I have two children now, both daughters. Lydia is 4, almost exactly a year younger than Henry would be; Genevieve is 3. Because I have struggled with anorexia, they will be more likely than other kids to feel its tug. But thanks to the struggle I had when their older brother died, they'll also get that you can fight it. Just like their mom.

Megan Othersen Gorman writes about health for Prevention and other magazines.